David LaCovey and his wife, Marsha
We’re putting the spotlight on a life changer who has not only made an incredible impact on how EMS treats and assesses pediatric patients in the Pittsburgh area, but around the world, David LaCovey.
LaCovey says he became involved in EMS like many other people of his generation, because of the TV show, Emergency. An experience during Boy Scouts solidified his decision. Two paramedics from his local community, Arlington County, Virginia, helped the scouts earn their first aid merit badges. This was the first time something felt intuitive to him. It made sense and he didn’t have to work at it.
In 1976, he became an EMT, and his parents relocated to Pittsburgh in 1977. He started his EMS career with Tri-Community South EMS in the South Hills as a volunteer. Mary Ann Scott taught him how to write trip sheets and during his time there, knew he wanted to become a paramedic. In those days, you had to be an EMT for a minimum of four years before you could apply to become a paramedic. His dad wanted him to go to college, and the Community College of Allegheny County (CCAC) had a two year associate degree program in emergency medicine where students would receive their college education at CCAC and their paramedic education through the Center for Emergency Medicine.
In 1981, LaCovey graduated and was hired by the City of Pittsburgh paramedics in 1982. He spent a little over 10 and half years with Pittsburgh EMS. Five years after being with the city, he was promoted to Crew Chief and received a position with the training division. This is where the educational part of his career began. Bill Miller and Pittsburgh EMS started him on the road to prehospital care when Ron Stewart was the Medical Director, and the training division put him on the road to education. LaCovey noted that at the time, there was not a lot of education specifically for pediatrics.
His interest in pediatrics started when his daughter was born. He approached his boss with the idea to put together some training days for Pittsburgh EMS based on pediatrics. His boss said run with it and LaCovey started working with Dr. Bruce Rosenthal and Dr. Holly Davis at Children’s Hospital putting together training days for Pittsburgh EMS. Then Children’s Hospital started a Prehospital Care Division with Neil Jones.
In 1990, Jones approached LaCovey and asked if he would be interested in leaving the city and working with him. LaCovey declined and two years later, Jones asked again. This time LaCovey applied, was hired, and spent the next 30 years with Children’s Hospital teaching pediatrics to not only in-house emergency care personnel with their PALS program, but also through a lot of outreach and education.
When asked about his biggest accomplishments, he listed a few in his illustrious career. Early on, when he was working with the City of Pittsburgh paramedics, he introduced intraosseous infusion into EMS. He worked with Dr. Susan Fuchs to design the first statewide protocol for EMS related to IO and the two also created the minimum pediatric equipment list that was going to be required for ambulance services in the Commonwealth.
Later in his career, he obtained a grant to fund and develop a program that was similar to the pediatric life support program, but was for BLS providers. There wasn’t a program like PEPP (Pediatric Education for Prehospital Professionals) available then. Dr. Bob Luten was working on something like that in Florida, when LaCovey traveled down for a train the trainer program. When he returned home, he worked with the Department of Health to develop a program that was approved and ran for 4-5 years. LaCovey said ALS providers had ACLS and PALS, but BLS didn’t really have anything. He has also written a couple chapters in books about pediatric resuscitation.
Something he didn’t strive for, but is incredibly grateful for, was being the 3rd recipient of the Amanda E. Wertz Memorial Emergency Medical Services for Children Award. This award is given yearly in memory of Amanda E. Wertz, daughter of Patrick and Elizabeth Wertz. Amanda was a child with special health care needs who died suddenly in 2001 at the age of 14. Amanda’s parents were both active paramedics in Pennsylvania for many years. The award honors an EMS provider who has made a difference in the lives of children in the Commonwealth of Pennsylvania.
LaCovey believes that if care providers looked back at his career, they would most remember his development of a pediatric field reference card and ambulance wall chart, which was one of the first things he did with Neil Jones. Both are still used worldwide. Years later and LaCovey still has care providers approaching him to let him know that they still carry that card with them. Technology is moving forward, and medical care apps becoming more prevalent, but as LaCovey said, the batteries in that card never die.
There have been many advancements in the equipment and technology used to care for pediatric patients throughout LaCovey’s career including innovative resources to assist in determining weight quickly, calculating drug dosing, and appropriate sized equipment. This started out with the Broselow Tape and then The Handtevy Program developed by Peter Handtevy, a former pediatric emergency fellow at Children’s Hospital. IO has been lifesaving in the ability to gain access to patients you weren’t previously able to gain access to in the past. But that access isn’t any good if you don’t know how the dosage for the medication or how to figure out the child’s weight.
But he notes there are still challenges for EMS providers.
One such challenge is that critically ill children represent a very small percentage of pediatric patients that are cared for by EMS providers. Globally, children make up about 10-11% of EMS call volumes and critically ill children make up about 1% of that, so that is a low frequency of a high acuity event when you have a very sick kid. He said as an educator, you want to make people feel confident in the care of the child. He would tell students that he couldn’t help them become comfortable caring for a child because comfort came from doing it often. Luckily, students wouldn’t have to do it too often.
Another challenge is how do you get EMS providers to learn vital skills that are needed to manage a critically ill patient in a controlled environment so that they become more comfortable in doing techniques such as airway management and drug calculations. If you walk into a room with a student and ask if the student can assist with the care, the parent is going to want the person with the most experience starting the IV. That’s where simulation plays a much better role. Virtual simulations and the quality of simulation mannequins have come from a long way. The challenge is, if you’re not at an academic center in a major EMS service you may not have the funding to obtain those quality simulations. Smaller or rural EMS just might not have those resources. How do we recognize and address that need.
LaCovey offered advice to those starting out in the field. Never stop learning. Never take an education program as something you have to do. You are going to find people who do not view prehospital care the way you do. Don’t let them drag you down. You will work your way onto a crew who will have a similar outlook on how a patient should be cared for and once you find them, just hang on to them. We’re all in it for the same reason, the patient. Don’t lose your empathy.
How does LaCovey feel about being called a life changer? He said it was humbling to be asked, and he’s been truly blessed to be thought of someone who has made an impact. Throughout his teaching career, he has told his students that he was going to teach them things they needed to know to pass a national registry exam, and things they’re going to need to know to do the job out in the field. Those are things you need to remember. You need to be able to recognize hypotension, ways to determine a child’s weight, and things like that.
The only recognition he would like to hear is from a previous student, saying they remembered something he said, and it helped them during their care of a pediatric patient. That is the best recognition anyone could ever as for.